Because of the limited amount of research that has been conducted with Hmong American elders, we expanded our literature review to include research that has been conducted with adults who are 21 years and older.
Difficulty in Understanding Chronic Cardiovascular Disease
Hmong American adults have had difficulties understanding and responding to chronic cardio-vascular disease (CVD) [that includes diabetes mellitus (DM), hypertension (HTN), stroke, heart attacks, kidney stones and kidney disease] for several reasons, including:
1. Lack of debilitating symptoms
The lack of debilitating symptoms from DM, HTN, and renal insufficiency until they have been present for many years, makes them easy to not recognize as needing treatment.
2. Lack of traditional concepts or words
There are no traditional concepts or words that directly relate to DM, HTN, hyperlipidemia, or proteinuria, which make them difficult to comprehend.
3. Economic and Social Factors
The biomedical treatment recommendations for new lifestyles are difficult to implement given the lack of physical activity in American society, unsafe urban neighborhoods, economical cost of rice compared to other foods, feelings of mistrust toward Western medicines, and the low income status.
Importance of Balance
Qualitative studies of Hmong people’s experiences with diabetes have confirmed the importance of imbalance in developing CVD and the need to restore balance in order to improve health (Culhane-Pera, Her & Her, 2007; Devlin, Roberts, Okaya, & Xiong, 2006; Henry 1996; Johnson 1995; Vang, 2005). These and other studies have indicated that similar ideas are present for other CVDs (Cha 2003; Culhane-Pera & Lee 2007; Wong, Mouanoutoua, Chen, Gray, &Tseng, 2006).
Similar to the traditional Chinese concept of yin/yang, Hmong cosmology conceives of a division between light/dark, seen world/unseen world, hot/cold, female/male, wet/dry, and other dichotomies (Cha 2000; Cha 2003; Culhane-Pera & Xiong, 2003).
Optimal health is achieved with a balance in all of these aspects, which is unique for each person. People, who feel out of balance, whether due to a change in the weather, food, germs, chemicals, or medications, will attempt to restore health through actions that could restore the balance. More specifically, Hmong Americans suffering from diabetes have attributed their illness to imbalances in food, chemicals, activity or mental health (Culhane-Pera, Her, & Her, 2007; Devlin, Robers, Okaya & Xiong, 2006; Gerdner, 2007; Vang, 2005). With regard to food, the increased consumption of rice is not viewed as a problem as much as eating foods that were grown with chemicals (i.e., fertilizers and pesticides). Imbalance is also believed to occur with the ingestion of fatty pork and sweets, or simply eating foods that do not agree with the individual.
Overall, Hmong Americans view themselves as being less physically active compared to their life in Laos. Less strenuous activity has lead to a decreased secretion of sweat believed to cause a poisonous build up of fats and salts in the body. In addition, weather has been viewed as a contributing factor to imbalance. For example, it is not uncommon for Hmong Americans, who have visited Southeast Asia, to report that they felt healthier in the warm climate of their homeland than in the U.S. Hmong Americans also identify a psychological component that contributes to imbalance.
Efforts to restore balance are made in an attempt to achieve optimum health. First, people must “listen” to their bodies to determine what works for them, what foods they can eat and what foods they should avoid and they must sweat, via hot weather or exercise (particularly gardening) (Culhane-Pera, Her, & Her 2007; Henry 1996.).
In short, they have to caiv, a Hmong word for cultural prohibitions regarding foods and activities in an effort to restore balance and health. While medications can help restore the balance, many people complain that Western medicines are too strong for them; rather, Asian herbal medicines are more useful because the medicines “fit” them. All people have to determine which of these activities are necessary for them, in order to restore their personal balance (Culhane-Pera, Her, & Her 2007).